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Indications of Chemotherapy

Late-stage cancer treatment Palliative or symptomatic treatment in cancer patients Treatment for cancer before and after surgery or radiation therapy Treatment for Lupus and Rheumatoid Arthritis

Classifications of Chemotherapeutic Agents

Alkylating Agents

Examples:

busulfan( Busufex,Myleran), carboplatin (Paraplatin), Chlorambucil (Leukeran),cisplatin (Platinol-AQ), cyclophosmide (Cytoxan), dacarbazine (DTIC-Dome),

hexamethylene amine or altretamine (Hexalen), ifosfamide (Ifex), melphalan (Alkeran),

oxaliplatin (Eloxatine), thiotepa (Thioplex)

Mechanism of Action

Alter DNA structure by misreading DNA code, initiating breaks in the DNA molecule,cross-linking DNA strands

Cell cyclenonspecific

Common Side effects

Bone marrow suppression, nausea, vomiting, cystitis (cyclophosphamide. Ifosfamide),stomatitis, alopecia, gonadal suppression, renal toxicity (cisplatin)

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Nitrosoureas

Examples:

Carmustine , lomustine or CCNU (CeeNU), semustine (Methyl CCNU [MeCCNU]),streptozocin (Zanosar)

Mechanism of Action

Similar to alkylating agents; cross the blood-brain barrierCell cycle- nonspecific

Common Side Effects

Delayed and cumulative myelosuppression,mespecially thrombocytopenia,nausea,vomiting

Topoisomerase I Inhiitors

Examples:

Irinotecan (Camptosar) Topotecan (Hycamtin)Mechanism of Action

Induce breaks in the DNA strand by binding to enzyme topoisomerase I, preventing cellsfrom dividing

Cell cycle- specific (S phase)

Common Side Effects

Bone marrow suppression, diarrhea, nausea, vomiting, hepatotoxicity

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Antimetabolites

5- Azacytadine, capecitabine (Xeloda), cytarabine (Depocyt, Tarabine) edatrexatefludarabine (Fludara), 5-fluorouracil (5-FU), gemcitabine (Gemzar), hydroxyurea

(Droxia, Hydrea), cladribine (Leustatin), 6-mecraptopurine (Purinethol), methotrexate

(Trexall, Rheumatrex), pentostatin (Nipent), 6-thioguanine (Tabloid)

Mechanism of Action

Interferes with the biosynthesis of metabolites or nucleic acids necessary for RNA andDNA synthesis

Cell cycle- specific (S phase)

Common Side Effects

Nausea, vomiting, diarrhea, bone marrow suppression, proctitis, stomatitis, renal toxicity(methotrexate), hepatotoxicity

Antitumor Antibiotics

Examples:

Bleomycin (BLM, Blenoxane), dactinomycin (Cosmegen), daunorubicin (DaunoXome),doxorubicin (Adriamycin), idarubicin (Idamycin), mitomycin (Mutamycin),

mitoxantrone (Novantrone), plicamycin (Mithracin)

Mechanism of Action

Interfere with DNA synthesis by binding DNA; prevent RNA synthesisCell cycle- nonspecific

Common Side Effects

Bone marrow suppression,nausea, vomiting, alopecia, anorexia, cardiac toxicity(daunorubicin, doxorubixin)

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Mitotic Spindle Poisons

Plant Alkaloids

Examples:

Etoposide (Toposar), teniposide (Vumon), vinblastin (Velban), vincristine (VCR[Oncovin]), vindesine (Eldisine), vinorelbine (Navelbine)

Mechanism of Action

Arrest metaphase by inhibiting mitotic tubular formation (spindle); inhibit DNA andprotein synthesis

Cell cycle- specific (M phase)

Common Side Effects

Bone marrow suppression (mild with VCR), neuropathies (VCR), stomatitisTaxanes

Examples:

Paclitaxel (Taxol), docetaxel (Taxotere)Mechanism of Action

Arrest metaphase by inhibiting tublin depolymerizationCell cycle-specific (M phase)

Common Side Effects

Bradtcardia, hypersensitivity reactions, bone marrow suppression, alopecia, neuropathies

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Hormonal Agents

Androgens and antiandrogens, estrogens and antiestrogens, progestins and antiprogestins,aromatase inhibitiors, luteinizing hormone-realeasing hormone analogues, steroids

Mechanism of Action

Bind to hormone receptor sites that alter cellular growth; receptor sites (antiestrogens);Inhibits RNA synthesis; suppress aromatase of P450 system, which decreases level

Cell cycle- nonspecific

Common Side Effects

Hypercalemia, jaundice, increased appetite, masculinization, feminization, sodium andfluid retention, nausea, vomiting, hot flashes, vaginal estrogen dryness

Miscellaneous

Asparaginase (Elspar), procarbazine (Matulane)Mechanism of Action

Uknown or too complex to categorizeCell cycle Varies

Common Side Effects

Anorexia, nausea, vomiting, bone marrow suppression, hepatotoxicity, anaphylaxis,hypotension, alter glucose metabolism

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